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A modified Nissen fundoplication: subjective and objective midterm results

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Abstract

Purpose

The failure rate of laparoscopic anti-reflux surgery is approximately 10–20%. The aim of our prospective study was to investigate whether a modified Nissen fundoplication (MNF) can improve reflux symptoms and prevent surgical treatment failure in the midterm.

Methods

The MNF consisted of (1) suturing the esophagus to the diaphragmatic crura on each side using four non-absorbable stitches, (2) reinforcing clearly weak crura with a tailored Ultrapro mesh, and (3) fixing the upper stitch of the valve to the diaphragm. Forty-eight consecutive patients experiencing typical gastroesophageal reflux disease (GERD) symptoms at least three times per week for 6 months or longer were assessed before and after surgery using validated symptom and quality of life (GERD-HRQL) questionnaires, high-resolution manometry, 24-h impedance-pH monitoring, endoscopy, and barium swallow.

Results

Mortality and perioperative complications were nil. At median follow-up of 46.7 months, the patients experienced significant improvements in symptom and GERD-HRQL scores. One patient presented with severe dyspepsia and another complained of dysphagia requiring a repeat surgery 12 months after the first operation. Esophageal acid exposure (8.8 vs 0.1; p < 0.0001), reflux number (62 vs 8.5; p < 0.0001), and symptom-reflux association (19 vs 0; p < 0.0001) significantly decreased postoperatively. The median esophagogastric junction contractile integral (EGJ-CI) from 31 cases (8.2 vs 21.2 mmHg cm; p = 0.0003) and the abdominal length of the lower esophageal sphincter (LES) (0 vs 16 mm; p = 0.01) increased postoperatively.

Conclusions

Our data demonstrate that the MNF is a safe and effective procedure both in the short term and midterm.

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Authors and Affiliations

  1. Department of Surgical Oncology and Gastroenterology, General Surgery, School of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy

    Sabrina Rampado, Angelica Ganss, Giulia Pozza & Romeo Bardini

  2. Department of Surgical Oncology and Gastroenterology, Gastroenterology Unit, School of Medicine, University of Padova, Padova, Italy

    Edoardo Savarino

Authors
  1. Sabrina Rampado
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  2. Edoardo Savarino
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  3. Angelica Ganss
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  4. Giulia Pozza
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Contributions

Sabrina Rampado: study conception and design, acquisition of data, analysis and interpretation of data, drafting the manuscript, and critical revision of the manuscript. Angelica Ganss: drafting the manuscript and critical revision of the manuscript. Giulia Pozza: acquisition, analysis, and interpretation of data. Edoardo Savarino: critical revision of the manuscript. Romeo Bardini: study conception and design and critical revision of the manuscript.

Corresponding author

Correspondence to Sabrina Rampado.

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The study was reviewed and approved by the Internal Review Board in Padova, Italy.

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All study participants provided written consent prior to study enrollment.

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The authors declare that they have no conflicts of interest.

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Rampado, S., Savarino, E., Ganss, A. et al. A modified Nissen fundoplication: subjective and objective midterm results. Langenbecks Arch Surg 403, 279–287 (2018). https://doi.org/10.1007/s00423-018-1660-7

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